Remarkable differences between three evidence-based guidelines on management of obstructive sleep apnea-hypopnea syndrome.

Objectives/hypothesis: The aim of this study was to compare available guidelines for the diagnosis and treatment of patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) regarding their content, conclusions on the available evidence, and recommendations.

Study Design: Literature review/systematic review.

Methods: We retrieved guidelines from Embase, PubMed, Web of Science, and Web sites of several health care improvement centers and with a Google Scholar search. We appraised the quality of selected guidelines according to the Appraisal of Guidelines for Research and Evaluation instrument. For similar clinical questions we compared the conclusions, the attached levels of evidence, and the references used. If differences were found, we checked search strategies, appraisal criteria, and publication date as possible sources for these differences.

Results: We selected the guidelines on diagnosis and treatment of OSAHS of the Scottish Scottish Intercollegiate Guidelines Network, the Dutch Institute for Healthcare Improvement, and the Institute for Clinical Systems Improvement in the United States for this comparison. For similar clinical questions these three guidelines showed conflicting conclusions (11%-18%), differences in attached levels of evidence (32%-62%), and remarkable discrepancies in cited studies. A plausible reason for these differences is the citation preference for articles from members of the guidelines workgroup and from their own country. Despite different publication dates, more recent guidelines fail to cite earlier published guidelines.

Conclusions: Despite the generally accepted approach regarding the development of evidence-based guidelines, remarkable differences exist between guidelines from different countries on the same clinical subject.